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<title>Untitled Document</title>
<style type="text/css">

body {
	background: url(<%= request.getContextPath() %>/images/history-bg.jpg) no-repeat center top;
}

#form1 table tr td table {
	font-family: "TH Niramit AS";
	font-size: 16px;
	color: #000000;
	font-weight: bold;
}
#form1 table tr td table tr td h5 {
}
#form {
	font-weight: normal;
}
#form {
	font-weight: normal;
}
#form {
	font-weight: normal;
}
#form {
	font-weight: normal;
}
#form1 {
	font-weight: normal;
}
#form2 {
	color: #000000;
	text-align: center;
}
#form3 {
	color: #000000;
}
#form3 {
	color: #000000;
}
#form3 {
	color: #000000;
}
#form3 {
	color: #000000;
}
#form3 {
	color: #000000;
}
</style>
</head>

<body>
<table width="910" height="236" border="0" cellpadding="0" cellspacing="3" align="center">
<tr>
	<td width="904" height="230"><%@ include file="/jsp/template/header.jsp" %></td>
</tr>
</table>
<table width="910" height="236" border="0" cellpadding="0" cellspacing="3"align="center">
<tr>
    <td width="213" height="468" valign="top"><table width="209" border="0" cellspacing="0" cellpadding="0">
      <tr>
        <td width="209" height="468" valign="top" bgcolor="#E2E2E2"><table width="210" border="0" cellspacing="0" cellpadding="0">
          <tr>
            <td width="219" height="45" valign="bottom"><a href="<%= request.getContextPath() %>/jsp/history.jsp"><img src="<%= request.getContextPath() %>/images/btn_1.png" width="206" height="40" /></a></td>
          </tr>
          <tr>
            <td height="45" valign="bottom"><a href="<%= request.getContextPath() %>/jsp/save.jsp"><img src="<%= request.getContextPath() %>/images/btn_2.png" width="206" height="40" /></a></td>
          </tr>
          <tr>
		<td height="45" valign="bottom"><img src="<%= request.getContextPath() %>/images/btn_3.png" width="210" height="40" /></td>
          </tr>
        </table></td>
      </tr>
    </table></td>
    <td width="758" colspan="3" valign="top"><form id="form1" name="form1" method="post" action="">
        <label for="hnId4"></label>
        <table width="688" height="469" border="0" cellpadding="0" cellspacing="0">
          <tr>
            <td width="688" height="210" valign="top"><table width="689" height="36" border="0" cellpadding="0" cellspacing="1">
              <tr>
                <td width="687" bgcolor="#5B8E0B">&nbsp;</td>
              </tr>
            </table>
              <table width="687" border="0" cellspacing="1" cellpadding="0">
                <tr>
                  <td width="685"><table width="686" border="0" cellspacing="1" cellpadding="0">
                    <tr>
                      <td width="65" rowspan="2" align="center" valign="middle" bgcolor="#CCCCCC">วันที่</td>
                      <td width="45" rowspan="2" align="center" valign="middle" bgcolor="#CCCCCC">CTRL</td>
                      <td width="45" rowspan="2" align="center" valign="middle" bgcolor="#CCCCCC">PT</td>
                      <td width="45" rowspan="2" align="center" valign="middle" bgcolor="#CCCCCC">INR</td>
                      <td colspan="7" align="center" valign="middle" bgcolor="#CCCCCC">Dose mg/day</td>
                      <td width="45" rowspan="2" align="center" valign="middle" bgcolor="#CCCCCC">TWD</td>
                      <td width="39" rowspan="2" align="center" valign="middle" bgcolor="#CCCCCC">%<br />
                        +/-</td>
                      <td width="39" rowspan="2" align="center" valign="middle" bgcolor="#CCCCCC">ADR</td>
                      <td width="40" rowspan="2" align="center" valign="middle" bgcolor="#CCCCCC">เภสัช</td>
                      <td width="68" rowspan="2" align="center" valign="middle" bgcolor="#CCCCCC">จน. เม็ดยา</td>
                    </tr>
                    <tr>
                      <td width="34" align="center" valign="middle" bgcolor="#E2E2E2">อา</td>
                      <td width="34" align="center" valign="middle" bgcolor="#E2E2E2">จ</td>
                      <td width="34" align="center" valign="middle" bgcolor="#E2E2E2">อ</td>
                      <td width="34" align="center" valign="middle" bgcolor="#E2E2E2">พ</td>
                      <td width="34" align="center" valign="middle" bgcolor="#E2E2E2">พฤ</td>
                      <td width="34" align="center" valign="middle" bgcolor="#E2E2E2">ศ</td>
                      <td width="34" align="center" valign="middle" bgcolor="#E2E2E2">ส</td>
                    </tr>
                    <tr>
                      <td align="center" valign="middle" bgcolor="#D5D5FF">&nbsp;</td>
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                    <tr>
                      <td height="26" align="center" valign="middle" bgcolor="#D5D5FF">&nbsp;</td>
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                    </tr>
                  </table></td>
                </tr>
            </table></td>
          </tr>
          <tr>
            <td height="133" valign="top"><table width="691" border="0" cellspacing="1" cellpadding="0">
              <tr>
                <td width="448" height="81" valign="top"><table width="448" border="0" cellspacing="0" cellpadding="0">
                  <tr>
                    <td width="144" height="80" valign="top"><table width="157" height="79" border="1" cellpadding="0" cellspacing="0">
                      <tr>
                        <td width="157" bgcolor="#999999" id="form2">ข้อมูลเพิ่มเติม</td>
                      </tr>
                    </table></td>
                    <td width="289" bgcolor="#E2E2E2">&nbsp;</td>
                  </tr>
                </table></td>
                <td width="240" rowspan="2" valign="top"><table width="236" height="130" border="1" cellpadding="0" cellspacing="0">
                  <tr>
                    <td width="226">&nbsp;</td>
                  </tr>
                </table></td>
              </tr>
              <tr>
                <td height="49" valign="bottom"><table width="450" border="0" cellspacing="0" cellpadding="0">
                  <tr>
                    <td align="center" bgcolor="#CCCCCC">Other MEDICATION</td>
                  </tr>
                </table></td>
                </tr>
            </table></td>
          </tr>
          <tr>
            <td height="126" valign="top" bgcolor="#FFFFFF"><table width="688" border="0" cellspacing="0" cellpadding="0">
              <tr>
                <td><table width="688" border="0" cellspacing="1" cellpadding="0">
                  <tr>
                    <td bgcolor="#CCCCCC">&nbsp;</td>
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                    <td bgcolor="#CCCCCC">&nbsp;</td>
                    <td bgcolor="#CCCCCC">&nbsp;</td>
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                    <td bgcolor="#CCCCCC">&nbsp;</td>
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                    <td bgcolor="#E1E1E1">&nbsp;</td>
                    <td bgcolor="#E1E1E1">&nbsp;</td>
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                    <td bgcolor="#DDDDFF">&nbsp;</td>
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                </table></td>
              </tr>
            </table></td>
          </tr>
        </table>
    </form></td>
  </tr>
  </table>
</body>
</html>
